Compcare UltraCare:
in-and-out of hospital benefits (2025))

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Compcare UltraCare. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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Terminology:

• PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
• DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
• Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
• All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

In-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Compcare: UltraCare
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	100% scheme rate	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Any Netcare hospital
Penalty for using other hospital:	n/a	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	Specialised radiology: R3,800 co-payment Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	MRI, CT Scans: Unlimited, with R3,800 co-payment unless PMB In and out of hospital benefit	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:		Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	R8,800 per family, in and out of hospital
Transplants:	PMBs only
Dialysis:	PMBs only
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
Alternatives to hospitals:	Step-down nursing, hospice and rehab: Unlimited, as authorised Nursing services after hospitalisation or in lieu of hospitalisation: 40 days per family. Paid from day to day benefit, but not from Above Threshold Benefit.
Casualty/ER:	One visit per child under 6 yrs: R1 300 paid by scheme	Gap Cover: Can cover ER claims (Plans coming soon)
Other:	.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Compcare: UltraCare
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child: Savings (per year): No savings account option on this plan The scheme might still cover some or all day-to-day claims. See below, and see benefits. Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account R16,000 R6,766 R2,631 Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit) R10,200 R7,600 R2,800 "Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid the self payment gap. Main= R9,660 Main+1= R17,200 Other Day-to-Day Funds:
PMBs out of hospital:	All schemes must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here. This can include consults with specialists, blood or other tests, radiology and medicine PMB benefits must never be paid from your savings account Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here. See our Guide to PMBs for more information.
GP consultations:	From day-to-day benefit
Childcare:	Newborn hearing screening test Newborn congenital hypothyroidism test Baby Wellness consult Immunisations Initial Occupational Therapy consultation Preschool eye, hearing and dental screening School readiness assessments Kid’s active benefit assessment and exercise prescription programme Kid’s nutritional benefit assessment and healthy eating programme	Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	From day-to-day benefit R5,200 per family if in Above Threshold Benefit
Pathology:	From day-to-day benefit R4,170 per family if in Above Threshold Benefit
General radiology:	From day-to-day benefit R4,170 per family if in Above Threshold Benefit
Specialised radiology:	MRI, CT Scans: Unlimited, with R3,800 co-payment unless PMB In and out of hospital benefit	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Scopes:		Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	R8,800 per family Paid From day to day benefit . Not paid from Above Threshold Benefit
General Appliances:	From day-to-day benefit Not paid from Above Threshold Benefit
1.1. Hearing Aids:	From day-to-day benefit
1.2. Wheelchairs:	See above
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Compcare: UltraCare
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child: Savings (per year): No savings account option on this plan The scheme might still cover some or all day-to-day claims. See below, and see benefits. Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account R16,000 R6,766 R2,631 Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit) R10,200 R7,600 R2,800 "Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid the self payment gap. Main= R9,660 Main+1= R17,200 Other Day-to-Day Funds:
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. First paid From day to day benefit Additional 38 chronic conditions covered, paid from day to day benefit
Acute (prescribed) medication:	From day-to-day benefit
Over-the-counter:	From day-to-day benefit
Birth Control:	From day-to-day benefit
On Discharge:	7 days per admission
Biological:	Biological medication: R261,000 per family with 25% co-payment on non PMB medication
View other benefits for this plan: In-hospital | Out-of-hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics You can also: Compare any two plans, side by side | View all the Compcare plans, with costs and brief summary. Find all other open medical aid plans here.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider